Tuesday, September 16, 2008


Tuesday's Tirade
NCQA ..."Those fuckingWeasels!"

Yesterday's economic news was very bleak. Today it is even bleaker. Now it is one of the world’s largest insurance company AIG who is struggling for its life. Listening to PBS News Hour with Jim Lehrer about the demise of Leyman Brothers and the continuing problems of insurance giant AIG causes great anxiety. What's gone wrong? Why? As many lose their savings and jobs, we ask instinctively, "Where are we headed?"

Analysts are quick to use terms like heavily leveraged. Under regulated. Wall Street shift. Privatizing profits at the cost of socializing losses. Draconian crisis. Gripped by fear. Loosened oversight....the list goes on.

What do our presidential candidates think? Knowing what I know about Coventry Health Care, Inc. of Bethesda, MD, the "darling of wall street" whose very own Wolf earned an obscene salary package of $32 million dollars in 2004, I would put my money on Obama with respect to this one issue.

September 15. 2008

"The challenges facing our financial system today are more evidence that too many folks in Washington and on Wall Street weren't minding the store," Obama stated in his first written statement on the crisis:

"Eight years of policies that have shredded consumer protections, loosened oversight and regulation, and encouraged outsized bonuses to CEOs while ignoring middle-class Americans have brought us to the most serious financial crisis since the Great Depression," he said.

While many may place the blame for this continuing meltdown on the unstable housing market, there are others who have spoken with far deeper insight. One hotspot, analysts believe, is the unbridled growth of markets without corresponding regulation. Too much freedom along with less regulation results in the perfect storm. A storm that has begun to develop in the insurance industry. Today AIG. Tomorrow, one might even consider Coventry Health Care, Inc., the real Coventry, a possible candidate.

If any news should cause serious protests, it will be learning of the reportedly deceitful, repugnant tactics of NCQA, a company whom people have trusted with there lives to offer honest evaluations of health care plans.

In 2006 the West Virginia Insurance Commission came down hard against Carelink Health Plans, Inc. of West Virginia. Carelink's response? They created legal juggernauts that caused evermore lengthy delays.

There was one lie after another, one more bold-faced than the next. The mother lode of lies was told in spring of 2008 when Carelink revealed its “Excellent” Accreditation from The National Committee for Quality Assurance, NCQA, headquartered in Washington D.C.

Consider these three facts and ask, “Is this an HMO with whom I would trust my health care and that of my family?”

1. Carelink knowingly inflicted great harm on me. Return to the ruthless letter sent me by Patrick Dowd, former CEO of Carelink, just one of many examples.

Here is the link to Mr. Dowd’s correspondence to me:

2. The West Virginia Insurance Commission issued Final Order 06-AP-024 against Carelink on December 14, 2006. This order describes Carelink’s “egregious” behavior and mandates radical change in how they do business so future abuses will be stopped. Carelink continues to ignore the order.

Here is the link to Final Order 06-AP-024 dated December 14, 2006. http://www.freewebs.com/courageoffaith/2006%2012%2014%20Final%20Order.pdf

3. I filed a civil lawsuit for lack of public accommodation for a person with a disability against Carelink on October 2007. My lawsuit cites a West Virginia law that prohibits anyone doing business in this state from discrimination against someone with a disability. While Carelink would like one to believe otherwise, they were first a business in West Virginia and then a health plan.

Here is the link to the civil lawsuit Christine Stenger v. Carelink Health Plans, Inc. of West Virginia and Patrick Dowd dated October 2007:

Did NCQA have its head buried in the sand when Carelink's accreditation application was processed? Worse yet, how can NCQA effectively evaluate a health care plan using VOLUNTARY INFORMATION? Even worse, US News and World Report relies partly on the NCQA's accreditations to determine the top 100 health plans each year. And people wonder why we have a health care crisis.

Isn’t that sweet?

According to NCQA’s website:

The National Committee for Quality Assurance is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda.

The NCQA seal is a widely recognized symbol of quality. Organizations incorporating the seal into advertising and marketing materials must first pass a rigorous, comprehensive review and must annually report on their performance. For consumers and employers, the seal is a reliable indicator that an organization is well-managed and delivers high quality care and service.

Measuring and reporting on health care quality is extremely important; it gives consumers and employers the ability to make informed choices and pursue the best available care.

NCQA consistently raises the bar. Accredited health plans today face a rigorous set of more than 60 standards and must report on their performance in more than 40 areas in order to earn NCQA’s seal of approval.

NCQA accreditation, according to one HMO’s advertising materials, is like the Good Housekeeping Seal of Approval. NCQA admits that they are a “private, not-for-profit organization.” Now strike out every other assertion. I repeat. Strike out every other assertion as what I tell you next will cast doubt on NCQA’s motives.

I believe that NCQA is yet another one of those organizations who are good at painting pictures. Rosy ones. Only these roses have thorns. Unfortunately, there is an unsuspecting public, a public that is duped despite their desire to locate an "excellent" health plan for themselves and their families.

Upon learning of Carelink's "excellent" accreditation, I contacted NCQA directly with a lot of questions. It was a very strange phone call and the information offered made me even more suspicious of NCQA.

The receptionist told me that she was taking thorough notes of my complaint to provide the complaint department. However, I was informed, I would have to make a formal complaint for any action to be taken. Sensing that my complaint would be a formality only, I closed this chapter. For a time.

Does NCQA think we John Does are all dummies and will go quietly away? I may not be the smartest person alive but I know enough to ask this question:

"How does an independent organizaton develop 'rigorous standards' by employing voluntary information and get away with it all these years?"

And am I smart enough to turn once again to the internet to locate answers? Yes. The search lasted less than five minutes and there is was. Bingo!

What a bold move on the part of managed care as reported in the expose Making a Killing, Chapter 6: HMOs and the Thread to Your Health by Jamie Court.

NCQA was formed in 1979 by the trade associations for the managed care industry — the American Managed Care and Review Association and the Group Health Association of America. The group was founded, in fact, to counter the federal government's attempts to monitor HMOs. The main funding source for NCQA continues to be HMOs, although the group is seeking to diversify its funding to appear more independent… And private report cards are maintained by industry-sponsored groups such as the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) and National Committee For Quality Assurance (NCQA).

Here's essential reading for you: http://www.freewebs.com/courageoffaith/MAKING%20A%20KILLING%20-%20Chapter%206%20-%20The%20Battle%20to%20Make%20Health%20Care%20Work.mht

Coventry Health Care, Inc., NCQA, the West Virginia Insurance Commission and the West Virginia Human Rights Commission will soon receive their own report cards. Over 900 visits were made to this site since its inception in early June. I have personally met others who plan to provide their own "voluntary information" to rate their health plans.

Recently I returned home from a national conference that focused on advocacy and self-help. No interest in the seminars. My only goal was to speak privately with the leaders of our association, advocacy leaders from around this country, and leave them with my a copy of this blog. I succeeded.

I brought up health care to a Canadian who had a key role to play in the convention. He knew about problems with health care as his sister-in-law lives in NY. When she suddenly became paralyzed from the chest down, problems receiving rightful benefits occurred with her health plan.

It was this gentleman who, upon reading a copy of today’s blog, exclaimed "Those fucking weasels! Excuse my French."

Dictionary.com defines a weasel as following:

1. cunning, sneaky person
2. a person who is regarded as treacherous or sneaky
3. They have a slender, elongated body, and are noted for the quickness of their movements and for their bloodthirsty habit in destroying poultry, rats, etc.
4. to use weasel words; be ambiguous; mislead

Take your pick.

It's time for more transparancy. Let’s hear more about the officers of Coventry Health Care, Inc. of Bethesda MD and study their personal business practices.

Where is this all leading? Look at today’s news. Wall Street is put on notice that it will be held accountable. Unfortunately, the public is losing much equity due to questionable business practices. That makes the public only angrier.

What was that fellow’s name? Oh, that’s right, Mr. Jeffrey Skilling. This Enron CEO was a little too arrogant. Like Coventry Health Care, Inc. of Bethesda MD, Enron was “a darling of Wall Street.” Look what happened to Enron. Is there another Enron out there where disclosure will reveal missteps, serious missteps? Is Coventry duplicating any of these types of tactics? Nothing would surprise me these days.

Tuesday’s Tale
David and Goliath

Find out just what people will submit to, and you have found out the exact amount of injustice and wrong which will be imposed upon them; and these will continue until they are resisted with either words or blows, or both. The limits of tyrants are prescribed by the endurance of those whom they oppress. ~Frederick Douglass:

A little over two weeks ago I visited my spiritual director, a diocesan priest with the Catholic Diocese of Wheeling Charleston (West Virginia). Father’s first words were, “I want you to reread the bible story of David and Goliath.” I smiled. “Father, I know the story well. For over two years I have had a small stone next to my computer, a reminder of God’s great power.”

What drives me day after day to fight for the rights of the poor against an evil health plan? Simply, Justice.

We know there is a systemic problem that weaves its way through the hearts and minds of good people whose conscience is misinformed. Through one entity after another, infiltrating the offices of those entrusted with public trust. Through regulatory agencies whose mission is to insure health insurance laws are followed by each insurance company that does business in a state. To the media whose choice of "no comment" by their very nature supports evil. And, yes, likely to the law firms that represent them, using legal means to stretch the truth, what some may call misrepresentation. More about this soon. Real soon.

Why did I think I could make a difference? From the moment Carelink Health Plans, Inc. of West Virginia denied me my rightful benefits, I have had honest, God-fearing men at my back. Doctors. Attorneys. And, most importantly, Catholic priests from the Catholic Diocese of Wheeling Charleston. One Franciscan Hermit. Two Jesuits, social activists. A diocesan priest. A Passionist priest.

Nothing surprised these men. They simply prayed harder. Encouraged and empowered more. And wisely blessed and advised me how to defeat Goliath. And while I have confronted fear and indifference from others, the clergy have never failed me these three, long, difficult years.

Their advice was always to keep on telling my story. Their belief is that one person can make a difference, that one by one others will begin to ask questions, to educate and inform their consciences. Change will occur slowly, but it is inevitable they tell me.

There is a crisis in health care in this country. The injustice I experienced is, sadly, a national issue. It must be a "WE" effort to advocate for others. Only together will we realize justice in health care. And then, the politically powerful will begin to face the anger of hardworking, faith filled Americans.

It’s about time, don’t you think?

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